Division of Pediatric Neurology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei 10675, Taiwan.
Nutrients. 2022 Oct 23;14(21):4457. doi: 10.3390/nu14214457.
Ketogenic diets (KDs) are a promising alternative therapy for pediatric refractory epilepsy. Several predictors of KD responsiveness have been identified, including biochemical parameters, seizure types, and electroencephalography (EEG) examinations. We hypothesized that graph theory-based EEG functional connectivity could explain KD responses in patients presenting focal onset seizure (FOS). A total of 17 patients aged 0-30 years old with focal onset seizures (FOS) were recruited as a study group between January 2015 and July 2021. Twenty age-matched children presenting headache with no intracranial complications nor other medical issues were enrolled as a control group. Data were obtained at baseline and at 12 months after initiating KD therapy (KDT) using the child behavior checklist (CBCL) and brain functional connectivity parameters based on phase-locking value from 19 scalp EEG signals, including nodal strength, global efficiency, clustering coefficient, and betweenness centrality. Compared with age-matched controls, patients presenting FOS with right or bilateral EEG lateralization presented higher baseline functional connectivity, including parameters such as global efficiency, mean cluster coefficient and mean nodal strength in the delta and beta frequency bands. In patients presenting FOS with right or bilateral EEG lateralization, the global efficiency of functional connectivity parameters in the delta and theta frequency bands was significantly lower at 12 months after KDT treatment than before KDT. Those patients also presented a significantly lower mean clustering coefficient and mean nodal strength in the theta frequency band at 12 months after KDT treatment. Changes in brain functional connectivity were positively correlated with social problems, attention, and behavioral scores based on CBCL assessments completed by parents. This study provides evidence that KDT might be beneficial in the treatment of patients with FOS. Graph theoretic analysis revealed that the observed effects were related to decreased functional connectivity, particularly in terms of global efficiency. Our findings related to brain connectivity revealed lateralization to the right (non-dominant) hemisphere; however, we were unable to define the underlying mechanism. Our data revealed that in addition to altered brain connectivity, KDT improved the patient's behavior and emotional state.
生酮饮食（KDs）是治疗儿科难治性癫痫的一种有前途的替代疗法。已经确定了几种 KD 反应的预测因子，包括生化参数、发作类型和脑电图（EEG）检查。我们假设基于图论的 EEG 功能连接可以解释局灶性起始发作（FOS）患者的 KD 反应。总共招募了 17 名年龄在 0-30 岁之间的局灶性起始发作（FOS）患者作为研究组，这些患者于 2015 年 1 月至 2021 年 7 月期间接受 KD 治疗（KDT）。还招募了 20 名年龄匹配的儿童作为对照组，这些儿童因头痛就诊，无颅内并发症或其他医疗问题。使用儿童行为检查表（CBCL）和基于 19 个头皮 EEG 信号的锁相值的脑功能连接参数，在开始 KDT 治疗（KDT）前和 KDT 治疗后 12 个月，分别获得数据，包括节点强度、全局效率、聚类系数和介数中心性。与年龄匹配的对照组相比，EEG 右侧或双侧偏侧化的 FOS 患者在基线时具有更高的功能连接，包括 delta 和 beta 频带中的全局效率、平均簇系数和平均节点强度等参数。在 EEG 右侧或双侧偏侧化的 FOS 患者中，KDT 治疗后 12 个月，delta 和 theta 频带的功能连接参数的全局效率明显低于 KDT 治疗前。这些患者在 KDT 治疗后 12 个月时，theta 频带的平均聚类系数和平均节点强度也明显降低。基于父母完成的 CBCL 评估，大脑功能连接的变化与社会问题、注意力和行为评分呈正相关。这项研究提供了 KDT 可能对 FOS 患者治疗有益的证据。图论分析表明，观察到的影响与功能连接的降低有关，特别是在全局效率方面。我们的研究结果与大脑连接有关，表明向右侧（非优势）半球偏侧化；然而，我们无法确定潜在的机制。我们的数据表明，除了改变大脑连接外，KDT 还改善了患者的行为和情绪状态。
